Exercise, Medicine, Teaching, Hyenas

Greetings from Hawassa!

Day number 2 of Marty sans Elliot in Hawassa, surviving, perhaps thriving. Elliot left yesterday early morning on a public van for Addis Ababa to fly to Washington DC for the African Studies Association meeting. He will be working with the other editors and the Board of the Association's journal, the African Studies Review. Heard from him this morning: he arrived safely but not without some issues. Apparently a psychotic man was roaming the aisles of the airplane and ranting, to the point that Elliot, who doesn't frighten easily, was frightened. BUT...  who should be on board the flight but A DELEGATION OF PSYCHIATRISTS, going to a convention! Apparently they applied valium and the therapeutic touch and all went smoothly thereafter.

Without him I am getting a whole lot of reading done. A lot of medical stuff. Finally was able to start my course on malaria from the London School of Tropical Medicine which, I must admit, is very cool. It is such a complicated disease: this little bugger of a parasite switches into at least four different forms in order to adapt to its mosquito and human hosts and has been able to resist each medicine we throw at it, change its outer cover so that creating a vaccine is extremely difficult, and infects approximately 50 million people a year, of whom about a million die. Most of them are children and most of those children are African children. A formidable enemy.

Also doing the mundane. Am doing a power point for the medical students on the evaluation and treatment of hypertension, the bread and butter of Global North medicine. Should be boring, but am doing a literature search and finding all kinds of things I hadn't known. Am supposed to fill up 2 hours (and Ethiopian education traditionally does not include time for questions from the students. :-(  ) But I think I can do it and maybe have some fun, (also not an Ethiopian educational tradition. :-(  )

And Sunday I had a lovely time presenting a power point lecture to the Hawassa Diabetes Association. Yes, it exists, started by my colleague at Referral, Dr. Tarike. It was a real treat, at least a hundred men and women, some in traditional dress, most non­English speakers, all diabetic, to whom I spoke about the role of exercise in treating diabetes. I interspersed my slides with pictures from the streets of Hawassa, proving that the little bit of obesity in town was directly correlated to transport by motorcycle or car, and that most of the walkers and bicyclers and pushcart folks were skinny as rails. Dr. Tarike translated into Amharic (and, judging by the relative lengths of some of his sentences compared to mine, did some augmenting and embellishing.) The questions were great, and I sure had a good time. 

For fun I am reading a book that several people – Sister Susy, Carolyn Oppenheim, Leah – had told me I must read, Cutting for Stone. I think because I still have an adolescent streak, I resisted it until getting here. Over 3 quarters of it takes place in Addis Ababa in the 1950's to 1970's and it truly is stunning. 
First of all Abraham Verghese is a magnificent writer. Second, it is a great story, woven with a truly multicultural cast of characters who do heroic things in difficult circumstances. Third, Addis Ababa 1960's has a lot of similarities to  Hawassa, 2011, and I can smell the smells, hear the sounds and see many of the sights that the hero does. And fourth, and most fascinating to me (Elliot, you kept telling me this) it is an ode to the practice of medicine, particularly medicine in extremely difficult, resource-poor, Ethiopian circumstances. It is that ode that I am particularly attuned to.

To digress, I was an unhappy medical student almost 40 years ago. It was a hostile, patriarchal, bourgeois profession that did not welcome a working-class socialist girl. I never felt part of the medical educational system at the time. It was closer to hazing than to glorious exploration of the science of the human body. I did well, but I never felt I fit in, and consequently never went the extra mile or claimed it as a fascinating, all-absorbing vocation. My joy was elsewhere – family and politics. 

That has changed over the years, as I have gotten into the mysteries of the science and its relationship to healing and the human life. Each year that goes by, I find myself wanting to know more – both reading the literature and exploring the intersection between that knowledge and preventing human suffering and death. It gives me excitement and joy. Hmmmm...

I have never seen that so well expressed as in Cutting for Stone. The hunger to learn, the frustration of making stupid, lazy mistakes, the inexpressible joy of making a diagnosis and knowing what to do about it.

I got so into this that for a while I was angry at myself for not having become a surgeon, as the Stones did in the book. Now THAT is an ahistorical joke! It took me a while to remember that I quit medical school after the first day of surgery because I was so disgusted by the anti-female, actually fairly anti-human atmosphere in the Duke Surgery Department. 

Well, I came to my senses re the surgical career issue. But I still appreciate the description of the passion for medicine. And then today I went to Referral and diagnosed my first case of Pott's disease, or tuberculosis of the spine presenting as paraplegia or bilateral leg paralysis and made my first diagnosis of Juvenile Rheumatoid Arthritis, both of which are possibly treatable. I was almost dancing down the hall. QED.

I am doing something else that I have always avoided, and that is teaching medicine. In retrospect I have avoided it, I think now, because I had so little respect for the medical educational establishment. Yet I have found that I really enjoy teaching in groups and one-on-one, and find, low-and-behold, that I have a lot to say and I say it in a way that surprises the medical students and interns and makes them smile, something that doesn't happen in Ethiopian medical education (an echo of my own from 40 years ago.) The girls in particular, and they are a pretty spunky lot and are about the same minority ratio as my own medical class, catch my eye and smile and answer. 

SOOO... El, I miss you, but am getting by. I am so glad you will have supper with Leah and Gavin tonight. Mulu, Masaye and Leah you are magnificent and I can't wait to see you. Arky, I would love your commentary on all this. Beloved, incomparable friends, keep Occupying and  know that we are there in spirit.

The hyenas howl every night outside our windows. Haven't heard them yet tonight. It is very odd – I find them comforting. I guess that is because they are outside. 

Goodnight and love to you,

Just Marty